构建体神经-内脏神经反射弧治疗脊髓脊膜膨出患者膀胱直肠功能障碍

Establishment of a somatic-spinat cord center-autonomic reflex pathway for spina bifida patients with neurogenic bladder and bowel dysfunction

目的探讨构建“体神经-内脏神经”反射弧治疗脊柱裂脊髓脊膜膨出患者大小便功能障碍的疗效。方法对4例脊髓脊膜膨出大小便功能障碍患者,行左侧L5前根近端与S3前根远端吻合,术前与术后8￣18个月行尿流动力学比较。结果4例均获得1年以上随访。3例高反射型患者于术后10￣12个月恢复可控性排尿,充盈性尿失禁消失,剩余尿逐渐减至(18±13)mL;1例无反射型患者于术后8个月获得控尿和自主排尿功能,尿失禁消失,排尿间期逐渐延长至2￣3h,逼尿肌压由1.29kPa增加至2.98kPa。4例患者在获得膀胱可控功能的同时,直肠肛门括约肌功能也转为基本正常,下肢功能损伤较小。结论建立人工体神经-内脏神经反射弧能有效地修复脊髓脊膜膨出所致的膀胱直肠功能障碍。

Objective To discuss the effect of artificial somatic-spinal cord center-autonomic reflex arc in the treatment of neurogenic bladder and bowe l dysfunction in spina bifida patients. Methods 4 patients with bladder an d bowel dysfunction caused by spina bifida underwent limited laminectomy and ven tral root (L5 to S3) microanastomosis since 2002. The urodynamic evaluation was performed before and 8~18 months after surgery. Results 3 cases with hyper -reflexia bladder achieved controllable voiding, whose residual urine volume dec reased from (88±22) mL to (18±13) mL and the detrusor external sphincter dis-s ynergism disappeared. 1 patient with areflexia bladder gained bladder control an d automatic micturition ability in postoperative 8 months. The detrusor pressure increased from 1.29 kPa to 2.98 kPa. All 4 patients with good bladder control g ained satisfactory rectum function. Lower limber motor functions damage was mini mal. Conclusion An artificial somatic-spinal cord center-autonomic reflex pathway can be established for patients with spina bifide to recover their bladd er and bowel functions.